Crohn's Disease P/t

[Stephanie5160]

Hello,

I had a 28 year old female patient admitted with a crohns disease flare. MD prescribed 1mg dilaudid every 4hrs prn and zofran. She was having diarrhea with rectal bleeding, vomiting, and low grade fever. MD completed a colonoscopy and EGD. Results showed gastritis, and biopsies were normal. MD changed dilaudid to every 6hrs prn, and add toradol. Patient was relieved but frustrated that she was still have terrible pain and the diarrhea with rectal bleeding. She was concerned she wouldn't be able to take care of her young children in her state. She asked the MD, what can be done about her crohns flare symptoms, but MD would continue to escalate her voice by saying, there's no crohns disease, this is not a flare! I don't need to give you dilaudid. And called for a psych and pain med consult. The patient was very distraught on how the MD was speaking to her. She asked, I'm sorry but are you giving me attitude? I'm very confused... all the while the MD talking over her. Patient started to cry and said she's very sensitive, and to have the MD judge her and automatically decide the patients pain level for her was very hurtful. Her emotional and physical well being was distressed with how this MD treated her. Personally I believe pain is subjective, and given that i physically saw her while she had painful bowel movements, pain, etc, the patient doesn't seem like. Drug seeker, she has genuine pain. Isn't there no cure for crohns? And even with the colonoscopy findings, it could very well still be a flare? Thoughts on how the doctor should have approached the situation? I felt so bad for this patient... anything I can do or recommend for her to do? Thanks!

[SaltySarcasticSally, LPN, RN]

As someone with Crohn's disease, some of these responses blow my mind a bit. I went undiagnosed for 10 years. Mainly because all of my biopsies were negative. This was due to the fact the part of my small bowel with Crohn's can't be reached with endoscopy or colonoscopy. It was until I went from 180 lbs to 130 lbs in 5 months that I was diagnosed by MRI.

The patient's biopsies being negative does NOT mean she isn't having a flare.

OP, I really appreciate you reaching out to better help your patient. I have zero drug abuse history. But I cannot tell you the amount of times I was treated as a drug seeker in the ER. I've had 3 large headed babies, the pain of labor has nothing on my Crohn's pain. I hate pain meds, they make me feel like I'm not in control of myself. But if I am hurting bad enough to go the ER, I don't care at that point, I just need relief. It is SO draining to be in extreme pain for days.

I don't know what it is about GI Dr's, but the vast majority I've met are arrogant and have no bedside manner. The Dr that diagnosed me is the only Dr I have been able to trust because he doesn't talk to me like I am making my pain up.

I've never heard opiates is contraindicated for Crohn's. Morphine IV is what I'm usually given in the rare times I do need emergent care. Usually that's when I'm so dehydrated I'm passing out. I do choose to not have an at home Rx for pain meds even though it was offered. I prefer to stick it out because 95% of the time, I can.

Just advocate for her and let her know you do believe her. Let her know she has options for providers, even while in patient.

Sorry for the novel but I'm just sick of the fact because there is a drug epidemic, anyone in severe pain that does not have a quick, visible cause is labelled a drug seeker.

Crohn's is an auto immune disease. It doesn't not have a one size fits all progression and it may not always be the picture perfect description of it. That doesn't mean it isn't real or that a psych consult is indicated.

[blondy2061h, MSN, RN]

I beg to differ- I've seen it a lot in my 40 years of practice. I've done it myself.

I've had care I've disagreed with in the hospital and asked for different providers. Small hospital. One hospitalist group. You got who was there at the time.

[TriathleteRN]

I was wondering the same.

[TriathleteRN]

Thanks for shedding light on the other side of this situation. As someone who has suffered with colitis all of my life and been told it's no big deal because it's not Crohn's I desperately needed a GI doctor who understood. I feel for this patient because I know what it's like to have MD's telling you it's all in your head, you're not in that much pain and you're just a drug seeker. I commend this nurse for advocating for this patient and if it were me, I'd be getting that patient a GI consult or another gastroenterologist that's not going to judge before taking all things into consideration.